The relationship between goal congruence and policy adoption among providers of child psychiatric services in Tennessee

Michael Cull, Tennessee State University

Abstract

This research tests a central assumption of principal-agent theory by exploring the interaction between provider's willingness to implement public sector managed care reforms and their willingness to adopt evidence-based practices (EBPs). Using an explanatory cross-sectional design, and survey method of data collection, the goals of Tennessee's managed-care model, TennCare, were compared with the goals of providers in Tennessee who provide psychiatric services to children. Three factors were identified that interact to support policy adoption: (1) high levels of goal congruence among providers, (2) high levels of commitment to the public interest and (3) a large proportion of providers with a pragmatic cognitive style. ^ The results of this study suggest a lack of “fit” between the “street-level” implementer and TennCare's management strategies which focus exclusively on controls and benefit limits. As public mental health policy moves toward new managed care models that place a greater emphasis on performance and evidence-based practice, policy-makers will need a better understanding of how profession-specific factors affect their ability to implement new policies. While the application of controls may be required in some situations, they must be balanced with appropriate application of inducements and a core appreciation for provider autonomy. The payer/provider divide may be successfully bridged if the system can leverage the strengths of shared goals and values. ^

Subject Area

Political Science, Public Administration|Psychology, Clinical|Health Sciences, Health Care Management

Recommended Citation

Michael Cull, "The relationship between goal congruence and policy adoption among providers of child psychiatric services in Tennessee" (2009). ETD Collection for Tennessee State University. Paper AAI3389308.
http://digitalscholarship.tnstate.edu/dissertations/AAI3389308

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